Lifestyle modification for weight loss: effects on cardiorespiratory capacity in Patients with Class II and Class III Obesity

Introduction: Prevalence of severe obesity is increasing, especially among the young Hispanic population. Methods: In the HCHS/SOL cohort of 18-74 year old US Hispanics, we examined gradients across BMI and age in CVD risk factors. Results: Approximately one in five males (total N = 6,547) and one in ten females (total N=9,797) met criteria for class II obesity (BMI 35 - 40 kg/m 2 ) or class III obesity (BMI ≥ 40 kg/m 2 ). The prevalence of hypertension, diabetes, and elevated C-reactive protein rose with each successive class of overweight/obesity. In contrast, the prevalence of elevated levels of total cholesterol, LDL-c and triglycerides increased across normal weight, overweight (BMI 25 - 30 kg/m 2 ), and class I obese (BMI 30 - 35 kg/m 2 ) groups, but did not increase in frequency across class I, class II, and class III obesity groups. The Figure depicts isolines that identify age- specific subgroups of the normal-weight and class II - III obese groups that had the same estimated prevalence of CVD risk factors, with 95 percent confidence intervals. Among young adults with class II or III obesity, the prevalence of hypertension, diabetes, and the combination of three or more CVD risk factors was similar to that among normal-weight individuals (BMI 18.5 - 25 kg/m 2 ) who were 15 to 30 years older. Among young obese individuals, the prevalence of low HDL-c levels and high C-reactive protein levels exceeded that among the oldest adults in the cohort. CVD risk factors had stronger, more consistent gradients across the BMI categories among men than among women. Conclusion: Class II and III obesity, defined as BMI ≥ 35 kg/m 2 , are common in the Hispanic/Latino population. Young adults with these severe forms of obesity have dramatically increased frequency of cardiometabolic risk factors. The age-related accumulation of multiple CVD risk factors, such as is typically seen in normal-weight individuals, is accelerated by 1-2 decades in severly overweight women and by 2-3 decades in severely overweight men.

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Effect of weight loss via bariatric surgery for class III obesity on exertional breathlessness

Respiratory Physiology & Neurobiology ◽

10.1016/j.resp.2019.05.007 ◽

2019 ◽

Vol 266 ◽

pp. 130-137 ◽

Cited By ~ 1

Author(s):

Amar Mainra ◽

Sara J. Abdallah ◽

Ryan E.R. Reid ◽

Ross E. Andersen ◽

Dennis Jensen

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Class Iii ◽

Class Iii Obesity

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381 The AspireAssist Is an Effective Tool in the Treatment of Class II and Class III Obesity: Results of a One-Year Clinical Trial

Gastroenterology ◽

10.1016/s0016-5085(16)30406-1 ◽

2016 ◽

Vol 150 (4) ◽

pp. S86 ◽

Cited By ~ 16

Author(s):

Christopher C. Thompson ◽

Barham K. Abu Dayyeh ◽

Robert Kushner ◽

Shelby Sullivan ◽

Alan B. Schorr ◽

...

Keyword(s):

Clinical Trial ◽

Class Ii ◽

Class Iii ◽

Class Iii Obesity ◽

One Year

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Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

Case Reports in Medicine ◽

10.1155/2014/786474 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Menachem M. Meller ◽

Amber B. Courville ◽

Anne E. Sumner

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Black Women ◽

Soft Tissue ◽

Hip Replacement ◽

Functional Independence ◽

Class Iii ◽

Hip Circumference ◽

Class Iii Obesity

The prevalence of class III obesity (BMI≥40 kg/m2) in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference) remains high.

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Obesity in pregnancy: maternal and perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204790 ◽

2020 ◽

Vol 9 (11) ◽

pp. 4444

Author(s):

Aishwarya V. Gupta ◽

Ami Mehta ◽

Bhargav Patel ◽

Karan Mehta

Keyword(s):

Weight Loss ◽

Perinatal Outcome ◽

Maternal Obesity ◽

Class Ii ◽

Class I ◽

Class Iii ◽

Medical Sciences ◽

Lower Segment Caesarean Section ◽

Obesity In Pregnancy ◽

Post Term Pregnancy

Background: The objective of this study was to find out the spectrum of complications during pregnancy due to maternal obesity with incidence and to assess the neonatal outcome.Methods: Retrospective study of antenatal patients was done in Sardar Vallabhbhai Patel Institute of Medical Sciences and Research (SVPIMSR), Ahmedabad from June 2019 to December 2019. Antenatal patients were categorized into 3 classes based on body mass index (BMI): class I=30-34.9 kg/m2, class II=35-39.9 kg/m2, and class III ≥40 kg/m2. The maternal and perinatal outcome of the patients was evaluated in relation to BMI.Results: A total of 61 women were included in the study, with 44 belonging to class I, 15 women to class II and 2 women to class III. In class I, 27% women had pre-eclampsia and its incidence increased with class II (69.2%) and class III (100%). The incidence of gestational diabetes mellitus (GDM) increases with increase in BMI (class I=5.4%, class II=7.6% and class III=50%). Incidence of fetal growth restriction (FGR) (7.6% and 2.7%) and post term pregnancy (38% and 16.2%) more in class II compared to class I respectively. Lower segment caesarean section (LSCS) rates are seen to be highest in class III (100%) as compared to class II (53%) and class I (50%). Class III (50%) women were more likely to have macrosomic babies than class II (40%) and class I (34.1%).Conclusions: Interventions directed towards weight loss and prevention of excessive weight gain must begin in the preconceptional period. Obese mothers must be counselled regarding risk and complications of obesity and importance of weight loss.

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Adverse right ventricular remodelling, function, and stress responses in obesity: insights from cardiovascular magnetic resonance

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab175 ◽

2021 ◽

Author(s):

Andrew J M Lewis ◽

Ines Abdesselam ◽

Jennifer J Rayner ◽

James Byrne ◽

Barry A Borlaug ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Cardiovascular Magnetic Resonance ◽

Stress Responses ◽

Severe Obesity ◽

Systolic Function ◽

Healthy Weight ◽

Class Iii ◽

End Diastolic Volume ◽

Class Iii Obesity

Abstract Aims We aimed to determine the effect of increasing body weight upon right ventricular (RV) volumes, energetics, systolic function, and stress responses using cardiovascular magnetic resonance (CMR). Methods and results We first determined the effects of World Health Organization class III obesity [body mass index (BMI) > 40 kg/m2, n = 54] vs. healthy weight (BMI < 25 kg/m2, n = 49) upon RV volumes, energetics and systolic function using CMR. In less severe obesity (BMI 35 ± 5 kg/m2, n = 18) and healthy weight controls (BMI 21 ± 1 kg/m2, n = 9), we next performed CMR before and during dobutamine to evaluate RV stress response. A subgroup undergoing bariatric surgery (n = 37) were rescanned at median 1 year to determine the effects of weight loss. When compared with healthy weight, class III obesity was associated with adverse RV remodelling (17% RV end-diastolic volume increase, P < 0.0001), impaired cardiac energetics (19% phosphocreatine to adenosine triphosphate ratio reduction, P < 0.001), and reduction in RV ejection fraction (by 3%, P = 0.01), which was related to impaired energetics (R = 0.3, P = 0.04). Participants with less severe obesity had impaired RV diastolic filling at rest and blunted RV systolic and diastolic responses to dobutamine compared with healthy weight. Surgical weight loss (34 ± 15 kg weight loss) was associated with improvement in RV end-diastolic volume (by 8%, P = 0.006) and systolic function (by 2%, P = 0.03). Conclusion Increasing body weight is associated with significant alterations in RV volumes, energetic, systolic function, and stress responses. Adverse RV modelling is mitigated with weight loss. Randomized trials are needed to determine whether intentional weight loss improves symptoms and outcomes in patients with obesity and heart failure.

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Obesity in pregnancy: maternal and perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20164647 ◽

2016 ◽

Vol 6 (1) ◽

pp. 141

Author(s):

Prameela H. J. ◽

Madhuri S.

Keyword(s):

Weight Loss ◽

Perinatal Outcome ◽

Maternal Obesity ◽

Class Ii ◽

Class I ◽

Care Providers ◽

Class Iii ◽

Obstetrical Care ◽

Class 1 ◽

Obesity In Pregnancy

Background: Obesity, the silent epidemic worldwide has reached a stage where approximately 2.3 billion adults will be overweight and more than 700 million adults will be obese by 2015, as projected by WHO. The objective of this study was to find out the incidence of the pregnancy complications due to maternal obesity and to assess the neonatal outcome.Methods: Retrospective study conducted in Cheluvamba Hospital, Mysore from September 2014 to September 2015. Subjects were categorized into 3 classes based on the BMI. Class 1:30-34.9 kg/m2, class 11:35-39.9 kg/m2, Class 111: >40 kg/m2. The maternal and perinatal outcome of the subjects evaluated in relation to body mass index.Results: A total of 56 women were included in the study, with 37 belonging to class I, 13 women class II, 6 women class III. Class III women were significantly more likely to have pre-eclampsia (83.3%, 69.2%, 27%) and post term pregnancy (50%, 38%, 16.2%) than class II and class I. The incidence of GDM (7.6%, 5.4%) and IUGR (7.6%, 2.7%) are more in class II compared to class I. Instrumental deliveries (10%, 28.5%) and LSCS (45.9%, 46.1%, 66.6%) rates increased as the BMI increased from class I to class III. Postpartum complications like PPH (5.4%, 7.6%, 33.3%) and wound gapping (7.6%, 16.6%) were on rise with increased BMI. Class III women were more likely to have macrosomic babies than class II and class III (33.3%, 15.3%, 18.9%).Conclusions: As the BMI increases pregnancy is more likely to get complicated. Interventions directed towards weight loss and prevention of excessive weight gain must begin in the pre-conception period. Obstetrical care providers must counsel their obese patients regarding the risks and complications conferred by obesity and the importance of weight loss.

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Effectiveness and Characterization of Severely Energy-Restricted Diets in People with Class III Obesity: Systematic Review and Meta-Analysis

Behavioral Sciences ◽

10.3390/bs9120144 ◽

2019 ◽

Vol 9 (12) ◽

pp. 144 ◽

Cited By ~ 3

Author(s):

Gabrielle Maston ◽

Alice A. Gibson ◽

H. Reza Kahlaee ◽

Janet Franklin ◽

Elisa Manson ◽

...

Keyword(s):

Systematic Review ◽

Weight Loss ◽

Prediction Interval ◽

Meta Analysis ◽

Average Weight ◽

Class Iii ◽

Dietary Interventions ◽

Initial Body Weight ◽

Class Iii Obesity

Severely energy-restricted diets are used in obesity management, but their efficacy in people with class III obesity (body mass index ≥40 kg/m2) is uncertain. The aims of this systematic review and meta-analysis were to determine the effectiveness and characteristics of severely energy-restricted diets in people with class III obesity. As there was a lack of publications reporting long-term dietary interventions and randomised controlled trial designs, our original publication inclusion criteria were broadened to include uncontrolled study designs and a higher upper limit of energy intake. Eligible publications reported studies including adults with class III obesity and that assessed a diet with daily energy intake ≤5000 kJ for ≥4 weeks. Among 572 unique publications from 4 databases, 11 were eligible and 10 were suitable for meta-analysis. Our original intention was to classify comparison arms into short-term (<6 months) and long-term (>1 year) interventions. Due to the lack of long-term data found, comparison arms were classified according to the commonalities in dietary intervention length among the included publications, namely dietary interventions of 4 weeks’ duration and those of ≥6 weeks’ duration. After a 4-week severely energy-restricted diet intervention, the pooled average weight loss was 9.81 (95% confidence interval 10.80, 8.83) kg, with a 95% prediction interval of 6.38 to 13.25 kg, representing a loss of approximately 4.1 to 8.6% of initial body weight. Diets ≥6 weeks’ duration produced 25.78 (29.42, 22.15) kg pooled average weight loss, with a 95% prediction interval of 13.77 to 37.80 kg, representing approximately 10.2 to 28.0% weight loss. Daily dietary prescriptions ranged from 330 to 5000 kJ (mean ± standard deviation 2260 ± 1400 kJ), and had wide variations in macronutrient composition. The diets were administered mostly via liquid meal replacement products. While the included publications had a moderate risk of bias score, which may inflate reported weight loss outcomes, the published data to date suggest that severely energy-restricted diets, delivered via diets of varying composition, effectively produce clinically relevant weight loss (≥10% of initial body weight) when used for 6 weeks or more in people with class III obesity.

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Efficacy of the treatment with dapagliflozin and metformin compared to metformin monotherapy for weight loss in patients with class III obesity: a randomized controlled trial

Trials ◽

10.1186/s13063-020-4121-x ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Aldo Ferreira-Hermosillo ◽

Mario Antonio Molina-Ayala ◽

Diana Molina-Guerrero ◽

Ana Pamela Garrido-Mendoza ◽

Claudia Ramírez-Rentería ◽

...

Keyword(s):

Weight Loss ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Class Iii ◽

Randomized Controlled ◽

Metformin Monotherapy ◽

Class Iii Obesity

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